Nondisp transverse fx shaft of unsp tibia, 7thR

This code describes a transverse fracture of the tibial shaft that is not displaced, meaning the bone fragments are still in their normal alignment. It specifically indicates that this is an open fracture of severe type (IIIA, IIIB, or IIIC) and that the patient is presenting for follow-up care due to malunion, where the fracture has healed in an incorrect anatomical position.

Use this code for a patient who has previously sustained a severe open transverse fracture of the tibial shaft, and during a subsequent encounter, the physician documents that the fracture has healed with malunion. This code is appropriate when the specific laterality of the tibia (left or right) is not documented.

• Ensure documentation clearly specifies "subsequent encounter" and "malunion" for this specific fracture type.
• Verify the open fracture type (IIIA, IIIB, or IIIC) was previously diagnosed and is relevant to the current malunion.
• Avoid using this code if the laterality of the tibia is known; instead, select a more specific code.